In our society, if teeth are noticeably irregular or protruding or if there is an obvious jaw deformity, people seek surgical orthodontic treatment to improve both jaw function and facial esthetics. The more severe problems with facial deformities cannot be corrected with orthodontics alone and will require a combination of surgery and orthodontic treatment. The patient’s physical health can be affected by a dentofacial deformity in several ways. If the problem is severe enough, chewing can be impaired, with an impact on digestion and general health. Most patients maintain adequate nutrition but learn to avoid certain foods that they simply cannot handle. Despite the marvelous adaptations that are possible in speech, tooth and jaw malposition can cause speech problems.
It is more difficult to maintain good oral hygiene if the teeth are markedly protruding and irregular, and patients who resent their teeth are less motivated to do so- thus susceptibility to tooth decay and gum disease may be increased. There is some evidence that temporomandibular (TM) joint pain and TMJ disease are more likely to develop in some types of jaw deformities. The National Research Council has reported that psychosocial impact of a dentofacial deformity is usually more important than the related physical problems. This is not to say that the physical impact is unimportant- the physical effects are both real and important-but rather that an individual’s entire life adjustment and role in life can be altered by the psychosocial effects.
If facial deformity exists it is recommended that the patient starts by visiting an orthodontist for an initial consultation and exam. The orthodontist will then refer the patient to an oral and maxillofacial surgeon he/she works with routinely to have a comprehensive treatment plan. This teamwork approach between the two specialists right from the beginning is very crucial to ensure the best possible results are achieved in correcting the dental as well as the facial/jaw positions. The patient undergoes an initial period of orthodontic treatment to align the teeth so that they will fit properly after surgery is completed.
Jaw surgery is usually scheduled after the teeth have been properly aligned, which could take as little as 6-7 months to 24 months. Orthodontic appliances used to align teeth prior to surgery are left in place during the surgical procedure to aid in stabilizing the teeth and jawbones. After the completion of surgery, there is a period of follow-up orthodontic treatment to achieve final alignment of the teeth, thus complementing the new facial symmetry.
In younger patients, surgery can be avoided by early orthodontic intervention, as early as age 7, to correct protrusions and/or retrusions of the jawbone. The orthodontist can use one of several orthodontic appliances to direct the bone growth, thus eliminating the need for surgery in some patients. However, in adults, and those patients who have completed their bone growth, the improper tooth/bone relationship will have to be corrected with orthognathic surgery.
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